A stroke can devastate the human body irreversibly and with little or no warning. So preventing strokes, rather than treating them, is a much better option. The key to stroke prevention is early identification of those at high risk and, according to a just launched program, a simple eye exam can identify a person's stroke risk.

"The eye diseases we identify are frequently a manifestation of larger blood circulatory system problems, including stroke, which is the third leading cause death in the United States," said Matthew E. Fink, MD, director of The New York Eye and Ear Infirmary's new program.

"Most people do not realize that the eye is part of the brain and that the same blood vessels feed both organs," explained Dr. Fink, "A vision problem can be caused by a blood vessel blockage to the brain, and could indicate a transient ischemic attack (TIA)], or mini-stroke; a carotid artery blockage; a heart valve problem where a platelet has broken off; or an occlusion of a vein. Our mission is to identify in the body the systemic cause of the vision loss, if there is one, and treat it to prevent stroke."

This new service is even more significant because The Infirmary has the highest volume of retina patients in the New York metropolitan area — 22,000 patient visits a year. Patients come to the center because of blurred vision, because they have diabetes, or simply for an eye exam.

"Until now, we have treated patients for specific eye diseases such as diabetic retinopathy and hypertensive retinopathy," said Thomas O. Muldoon, MD, director of the Retina Service at the Infirmary. "Now, with the opening of the new neurovascular service, we are greatly expanding our horizons. We are screening and testing these same patients with eye disease, many of whom are at high-risk for general blood vessel diseases and stroke, and educating them about prevention and then referring them for treatment."

Once referred to the neurovascular service, high-risk patients undergo a thorough evaluation, which may be followed up by diagnostic tests — blood tests, ultrasound exams, Doppler echograms, standard CT and MRI imaging — and screening tests for peripheral vascular diseases. These tests determine the location and severity of a potential blood vessel problem, such as a blockage of the carotid artery. Patients are then educated about preventive measures and referred for appropriate treatment.

Stroke is caused by disruption of blood flow to the brain. Early symptoms include sudden vision loss; sudden numbness of the face, arm or leg; sudden confusion; trouble speaking or understanding; sudden dizziness; loss of balance; and sudden severe headache.

Each year about 700,000 people experience a stroke, according to the American Stroke Association, a division of the American Heart Association. About 500,000 of these are first attacks. Stroke accounted for more than one out of every 15 deaths in the United States in 2001.